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The main concerns of the patient SYMPTOMS:Gingival Bleeding, Pain and Swelling.Tooth mobility.Bad breath and taste.
Bleeding Bleeding During Tooth Spontaneous Spontaneous Spontaneous During Mastication During Mastication Tooth Brushing Tooth Brushing Mastication Brushing A sudden onset or deterioration may suggest an underlying systemic factorsAcutePeriodontal Acute Periodontal Acute Periodontal Pain Pain Dentine Lesions (NUG) Lesions (NUG) Dentine Lesions (NUG) Hypersensitivity Hypersensitivity Pulp and Periapical Pulp and Periapical Caries Caries Disease Disease
Any Any Increased? Increased? Masticatory Masticatory When? When? (Duration) Difficulty Difficulty (Duration) Tooth Mobility Tooth MovilityCauses of tooth mobility: Marginal or apical inflammation. Loss of connective tissue attachment and supporting bone, usually due to marginal periodontal disease but occasionally due to periapical disease. Apical root resorption. Increase in width of periodontal ligament, usually due to occlusal forces.
OBJECTIVES:1. To identify systemic factors which may help to account for the periodontal condition, ex: Pregnancy, Diabetes Mellitus.2. To note the existence of systemic condition for which especial precautions (ex. Antibiotic prophylaxis) are required to safeguard the patient during the periodontal therapy.3. To note the presence of any transmissible disease which may present a hazard to the clinician, dental surgery staff or other patients.
Patients attitude toward dental health. Date and nature of the last dental treatment. Regularity of previous dental treatment. Oral hygiene habits. a. Tooth brush (type and frequency) b. Dental floss. c. Others. Habits related to oral health or disease (bruxism, smoking)
1. Gingival Inflammation, Plaque and Calculus GINGIVITIS GINGIVITISChangesofof Changes Gingival Gingival Exudate the colour the colour Exudate Enlargement Enlargement (edema or hyperplasia) Bleeding Bleeding (edema or hyperplasia) Supuration, Ulceration Supuration, Ulceration or Sweeling (acute inflammation) or Sweeling (acute inflammation)
1. At the initial visit.2. During the subsequent appointments to control the progress of the treatment.
• Is used to:1. Identify pockets which bleed on probing.2. To measures the pockets depth.
The depth to which the periodontal probe can penetrate beyond the gingival margins depends on:1. The amount of gingival enlargement.2. The extent of connective tissue attachment loss.3. The resistance of the tissue to probing, determined by the extent to which gingival collagen has been replaced by inflammatory infiltrate.
4. The size, shape and tip diameter of the probe.5. Use of the probe, angle of insertion and pressure applied.6. The presence of obstructions such as subgingival calculus.7. The patients reaction to the discomfort on probing.
• Each tooth should be rocked between an instrument handle and index finger in a buccolingual direction and mesiodistal direction (when the adjacent tooth is not present).
• The amplitude of tooth movement of the crown tip from its most extreme buccal (or mesial) position to its most extreme lingual or distal position should be observed:Grade 1- Visible horizontal mobility up to 1 mm.Grade 2- Visible horizontal mobility between 1 and 2 mm.Grade 3- Visible horizontal mobility greater than 2 mm or rotation or vertical mobility (depression).
Parafunctional habits• The occlusion should be examined for detect premature or interfering contacts as contributory factors.• Vertical bone destructive pattern is often associated with traumatic occlusion.
• Radiographs may:1. Show the proportion of support loss in relation to root length, the pattern of bone loss and the rate of destruction.2. Reveal unerupted teeth, periapical pathology, inadequate endodontic treatment, proximal caries, overhanging margins, etc.
Pulp Vitality Test Teeth associated with deepTeeth associated with deep To distinguish a periapical To distinguish a periapical Periodontal pocket Periodontal pocket (pulpitis or pulp necrosis) from periodontal abscess from periodontal abscessHaematological investigations, ex: full blood count in patients where blood dyscrasias are suspected(neutropenia, leukemia, etc)
Tooth by tooth diagnosis. Whole dentition. For an individual patient.
It depends on:• The adequacy of the diagnosis.• The quality of the treatment, including home care and recall maintenance.Factors that may influence the prognosis: The extent and significance of mucogingival problems. The extent of furcation lesions. The combined periodontal and endodontic lesions. The presence of the hopeless teeth.